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Based on observation and staff interview, the facility failed to ensure that patient care supplies were maintained according to the manufacturer's specifications. Findings include:

During the review of the single anesthesia cart in the operating room of the facility on 9/14/10 at 2:30 p.m., the surveyor observed the following outdated patient care supplies:
4 packages of 1/2 inch by 4 inch Steri-strip wound closure devices with the manufacturer's expiration dates of 11/2006 (1) and 4/2007 (3).
2 Tegaderm 4 inch by 4 3/4 inch sterile occlusive dressings with the manufacturer's expiration date of 5/2005.

In an interview with Staff Member D at 2:45 p.m., the staff member stated that the nurse anesthetist was responsible for the maintenance of the supplies on the cart and did not know why those supplies were on the anesthesia cart.

Based on observation and staff interview, the facility failed to ensure that mislabeled medications were not available for patient use. Findings include:

During the review of the single anesthesia cart in the operating room of the facility on 9/14/10 at 2:30 p.m., the surveyor observed the following opened multidose vials were not labeled as to the date of opening:
-1 open, partially used Labetalol 100 milligrams per 20 milliliters (20 milliliter vial). The vial was not marked as to when it was opened.
-1 open, partially used 30 milliliter vial of Normal saline. The vial was not marked as to when it was opened.
-1 open, partially used 30 milliliter vial of 1 % Lidocaine solution. The vial was not marked as to when it was opened.

In an interview with Staff Member D at 2:45 p.m., the staff member stated that the nurse anesthetist was responsible for the medications and supplies on the anesthesia cart and staff member D did not know why the open vials were not dated.

Based on document review and staff interview, the facility failed to ensure that the clinical records of 10 (#s 3, 6, 7, 8, 9, 10, 11, 13, 16, and 26) of 30 sampled clinical records were completed. Findings include:

During the review of emergency room records beginning on 9/14/10 at 3:30 p.m., the surveyor noted the following incomplete records:

1. Patient #3 was in the emergency room on 4/2/10 for treatment of an allergic reaction to a medication. The facility form labeled "Emergency Department Services/Outpatient Surgeries, Consent to Treatment and or Procedure" was blank. The patient did not sign, date, and time the consent for treatment.

2. Patient #6 was in the emergency room on 4/11/10 for treatment of a syncopal episode. The facility form labeled "Emergency Nursing Record - General medicine Complaints" did not document the time when the treating provider was notified of the patient's presence or the time when the provider actually saw the patient.

3. Patient #7 was in the emergency room on 5/2/10 for complaints of shortness of breath. The facility form labeled "Emergency Nursing Record - Respiratory Complaints" did not document the time when the treating provider was notified of the patient's presence in the emergency room or the time when the provider actually saw the patient.

4. Patient #8 was in the emergency room on 5/10/10. The facility form labeled "Emergency Nursing Record - Respiratory Complaints" did not document the name of the treating provider, the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

5. Patient #9 was in the emergency room on 5/15/10 for trauma to the left lower leg. The facility form labeled "Emergency Nursing Record - Extremity Trauma" did not document the name of the treating provider, the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

6. Patient #10 was in the emergency room on 5/22/10 for complaints of respiratory distress. The facility form labeled "Emergency Nursing Record - Respiratory Complaints" did not document the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

7. Patient #11 was in the emergency room on 5/25/10 for complaints of generalized weakness. The facility form labeled "Emergency Nursing Record - General Medicine Complaints" did not document the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

8. Patient #13 was in the emergency room on 6/16/10 for treatment of burns to the right lower extremity. The facility form labeled "Trauma Flow Sheet" did not document the name of the treating provider, the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

9. Patient #16 was in the emergency room on 9/2/10 for treatment of lacerations. The facility form labeled "Emergency Nursing Record - Head/Face Trauma" did not document the name of the treating provider, the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

10. Patient #26 was in the emergency room on 7/13/10 for symptoms of a transient ischemic attack. The facility form labeled "Emergency Nursing Record - Neurological Complaints" did not document the name of the treating provider, the time when the treating provider was notified of the patient's presence in the emergency room, or the time when the provider actually saw the patient.

In an interview with Staff Member P on 9/15/10 at 10:00 a.m., the staff member verified the records were incomplete.